This R21 application proposes to develop and test an adaptation of Enhanced Milieu Teaching (EMT), a naturalistic evidence-based caregiver-implemented communication intervention for young children with language impairment. The culturally and linguistically adapted intervention, EMT en Espaol, addresses a critical need for evidence-based communication interventions for an underserved population, Spanish-speaking children and their families from low-income households. Spanish-speaking caregivers who have children ages 30 to 42 months evidencing receptive and expressive language delays will be eligible. Caregiver-implemented intervention to support the development of home language is recommended for young children with language impairments; however, there are currently no evidence-based, culturally and linguistically appropriate interventions teaching Spanish-speaking caregivers language support strategies for very young children with significant language delays. The proposed project includes: (a) conducting a randomized trial of EMT en Espaol, a 4-month home-based intervention, with 40 caregivers and their children with language delays; (b) examination of caregiver use of EMT en Espaol strategies (responsiveness, matched turns, target talk, expansions, prompting) before intervention, after intervention and 3 months after intervention (c) exploring the impact of intervention on child expressive and receptive vocabulary post-intervention and at the 3 month follow up; and (d) assessing the acceptability, perceived effectiveness, and cultural appropriateness of the intervention. The development of assessment protocols, intervention materials, and caregiver training procedures, together with data on parent and child outcomes from the RTC and the feasibility evaluation will provide the basis for a subsequent, large scale randomized control trial to examine the impact of caregiver-implemented home language intervention on critical long term outcomes including vocabulary, complex syntax, and reading in both Spanish and English for young children with language impairment. This intervention development project addresses the NIH goal of reducing disparities in access to health promoting interventions as well as the NIH research agenda to address the health needs of racial and ethnic minorities, rural and urban poor, in order to improve access to care for underserved populations.